Understanding Pain

February 26, 2008
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Novus Medical Detox Center

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At Novus Medical Detox Center, many of our patients tell us that they came to us because their lives were being ruined by highly addictive narcotic painkillers like OxyContin, Lortab, Percocet, oxycodone or even, in a few instances, methadone that was prescribed by medical doctors to treat pain. When our patients arrive at Novus on these painkillers they normally complain of two or more of the following conditions:

Anxiety

Depression

Inability to concentrate

Slowed reaction times

Decreased or no sex drive

Fear

Hopelessness

Anger

Insomnia or other sleep problems

Pain

Some of our patients are not addicted to the drugs, in the classic sense, but merely dependent, meaning that they experience severe withdrawal symptoms if they try to stop taking the painkiller. Let's examine what is pain, the way it is sensed and some of the more common types.

WHAT IS PAIN?

At one time or another all of us have experienced pain. We have all touched a hot object, fell and banged our elbow or scraped our knee, gotten a headache, or ached the next day after helping someone move to a new apartment.

All of the above uncomfortable sensations we call pain. Almost always, the pain will go away in a few hours to as much as a day or so. For some, though, their pain doesn't go away in a day but stays with them for the rest of their lives until they can find a way to deal with it.

The International Association for the Study of Pain defines it as: "An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage."

HOW DO WE PERCEIVE PAIN?

This is not an easy answer, but most scientists believe that pain signals originate in the thalamus (either of a pair of egg-shaped masses of gray matter in the brain that relay sensory information) and are sent from there to the cerebral cortex (the headquarters for complex thoughts). It is also theorized by some scientists that the thalamus is where images, like those of injuries to the body, are stored for recall by the brain.

Apparently, a neurotransmitter (a chemical that carries messages between different nerve cells or between nerve cells and muscles) stimulates a receptor (a part of an adjoining nerve cell) to send out a distress signal that something is wrong, and this is the way that our brain senses pain.

Scientists have identified a type of receptor that responds to painful stimuli called a nociceptor. A nociceptor is a thin nerve fiber in the skin, muscle, and other body tissues that, when stimulated, carries pain signals to the spinal cord and brain. While normally nociceptors only respond to physical pain, they can be made more sensitive because infections or sunburns or other things that would not have necessarily caused pain will now-like patting someone on their sunburned back.

WHAT IS THE PURPOSE OF PAIN?

Most scientists agree that pain is used by the body to warn of a non-optimum situation or danger to the body and to signal that immediate action must be taken. For example, holding your finger on the hot plate will be very destructive if not removed quickly. Lifting too heavy a load can permanently injure the back, so your body sends out an immediate warning by making you feel pain and then you set the load down. Looking at too bright a light is painful and if you don't look away it could cause permanent damage to your optic nerve.

Of course, some people will react to pain like the cat described by Mark Twain. They will never jump on a hot stove again but they also will not jump on a cold stove. We all know people who have had a relatively minor bicycle accident who will never ride a bike again. This is an example of their body's pain mechanism actually interfering with them doing some things that might add pleasure to their lives.

If the condition causing the pain is not corrected, the pain can become so severe that it takes over the person's life.

HOW IS PAIN DIAGNOSED?

While it is extremely frustrating to patients, medical professionals and insurance companies, there is no test that can accurately measure the intensity of pain and often no way to accurately diagnose the real cause of the pain. Of course, if the pain is due to a trauma or something shows up on a magnetic resonance image (MRI) or simple X-ray, then the cause can be located.

ACUTE AND CHRONIC PAIN

Pain is generally divided into two areas-acute and chronic.

Acute Pain

Generally acute (severe and of a short duration) pain is normally caused by disease, inflammation, or injury. It generally comes on suddenly and though it may be severe it generally will start to lessen and will eventually go away.

Chronic Pain

Chronic (long lasting) pain may vary in intensity but it persists over a longer period of time than acute pain. By definition, chronic pain is pain that has not been successfully treated. Our patients who come to Novus to get off painkillers prescribed by doctors are suffering from chronic pain and that is what we will discuss.

COMMON TYPES OF CHRONIC PAIN

While not a complete list of the types of chronic pain suffered by Novus patients, most of them have pain derived from one of the following types:

Arachnoiditis

The arachnoid is the middle of the three membranes that envelop the brain and spinal cord. The suffix "-itis" means inflammation or disease. (Some confuse arachnoid with arachnids-spiders, but this is not the same thing.) Arachnoiditis is the inflammation of the membrane that surrounds and protects the nerves of the spinal cord (a thick whitish cord of nerve tissue extending from the bottom of the brain through the spinal column, which together with the brain forms the central nervous system).

The arachnoid can become inflamed in the following way:

* Because of an irritation from chemicals such as the dye used to provide contrast to x-rays, CT or MRI scans or from steroid injections;

* Because of an infection from bacteria or viruses;

* Because of direct injury to the spine such as from an accident;

* Because of complications from spinal surgery or other invasive spinal procedures.

Inflammation of the arachnoid often leads to the formation of scar tissue and adhesions which cause the spinal nerves to "stick" together and this can cause a number of symptoms such as:

* Numbness

* Tingling

* Stinging, shooting and burning pain in the lower back or legs

* Debilitating muscle cramps, twitches, or spasms

* Impairment in bladder, bowel, and sexual function

* Paralysis of the lower limbs.

Back Pain

While arachnoiditis certainly is a cause of back pain, there are other causes including:

* Sciatica--pain that spreads to the legs

* Degenerated or ruptured discs in the spine (discs are sponge-like padding between the vertebrae (bones) in the spine that act as shock absorbers)

* Migraines--throbbing pain and sometimes other symptoms, such as nausea and visual disturbances, which can be triggered by stress and have led to strokes. They are more frequent in women than men.

* Cluster--excruciating, piercing pain on one side of the head. They occur more frequently in men than women.

* Tension--a tight band around the head.

Fibromyalgia

Fibro (fiber or tissue) -myalgia (muscle pain) is a disorder that affects many more women than men. The actual pain comes not from the joints but from the connecting tissues such as the muscles, tendons and ligaments.

Neuropathic Pain

Neuro (nerves) -pathic (affected by disease) usually results from an injury to:

* The nerves in the peripheral nervous system (the part of the nervous system that is outside the central nervous system and comprises the cranial nerves excepting the optic nerve, the spinal nerves, and the autonomic nervous system)

* The nerves in the central nervous system (the part of the nervous system which in vertebrates consists of the brain and spinal cord, to which sensory impulses are transmitted and from which motor impulses pass out, and which supervises and coordinates the activity of the entire nervous system).

Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation. It can result from:

* Diseases that affect nerves (such as diabetes)

* Trauma (a physical injury or wound to the body)

* Cancer treatment with chemotherapy drugs which can affect nerves

PAIN MANAGEMENT

Many of us who have experienced extreme and chronic pain wish that we were like the lady who went to her doctor complaining of pain. The doctor asked, "Where are you hurting?" "I hurt all over", said the lady. "What do you mean, all over?" asked the doctor. "Please be a little more specific."

She touched her right knee with her index finger and yelled, "Ow, that hurts." Then she touched her left cheek and again yelled, "Ouch! That hurts, too." Then she touched her right earlobe, "Ow, even THAT hurts," she cried.

The doctor checked her thoughtfully for a moment and told her his diagnosis, "You have a broken finger."

Doctors know how to fix broken fingers but very often are unable to cure chronic pain and have to resort to merely masking the pain using painkillers (narcotics). While no one likes to see anyone in pain, at Novus Medical Detox Center we see countless patients who have become dependent (they have withdrawal symptoms if they try to stop taking the painkiller) or addicted to painkillers prescribed by their doctors.

Many doctors have termed their practice "Pain Management," and this is a correct description because the cause of the pain is seldom addressed but simply "managed." Since the purpose is often not to eliminate the pain but to "manage" it, the fact is that even after a number of years of "treatment", in many cases the pain is still there.

However, most people "managing" their pain with painkillers are forced to take higher and higher doses of the painkillers to mask the pain. Taking more painkillers results in more side effects, more trouble thinking and doing what used to be normal cognitive activities.

SPINE PROBLEMS

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Because the majority of our patients were made dependent on or became addicted to painkillers because of back pain, let's set out a basic explanation of the spine.

The spine is composed of vertebrae (bones) and are generally divided in this way:

Round, spongy pads called discs lie between the vertebrae. In many cases, these discs can shift, bulge, or degenerate and this will cause pain.

Instead of attempting to treat the conditions affecting the spine, many doctors have recommended surgery and this, for most people, results in permanent pain.

SOME NON-DRUG TREATMENT OPTIONS

It is easy to prescribe a painkiller to mask the pain. Another treatment for back pain is to inject steroids in the spine that provide temporary relief but are known to cause bone problems-look at the athletes and body builders who took steroids but now have trouble walking. Both of these treatments may help with the pain, but they also create long term problems and don't even attempt to handle the cause of the problem.

However, before giving up your life to pain or to surgery, narcotics or other drugs, you should explore other alternatives that might address the cause of the pain. Some are more successful than others and many of these alternatives are very dependent on the skill of the person applying them.

A word of caution is in order. While not intending to be demeaning to the medical profession, it is important that you approach the selection of medical treatment with the same amount of questions, preparation and skepticism that you have when you purchase a new car. There is no reason that a medical professional's office should not be prepared to explain how and why their proposed treatment will produce results for you and to answer any questions that you have. If they don't have time to answer your questions or do not answer them to your satisfaction, then my suggestion is to locate another treatment provider.

Acupuncture: Acupuncture is an ancient Oriental process. It is the placement of needles at precise points on the body to increase blood flow to speed healing and stimulate changes, such as increasing the body's natural pain modulators (endorphins). People who have had acupuncture from someone on a cruise ship or from a practitioner who attended a weekend seminar have generally not experienced much relief. However, several of our patients who left Novus and received acupuncture from an experienced practitioner reported relief from pain and generally felt better over time as they continued to receive acupuncture.

Biofeedback: The person seeks to gain control over muscle tension, heart rate, and skin temperature. If the person gains control over these things, the belief is that they will be able to relax their muscles and slow their heartbeat so that they can change their response to pain. While some people attest to the relief they have attained, many others have tried and abandoned this form of treatment.

Capsaicin Cream: A cream containing capsaicin, a chemical found in chili peppers, that often provides relief from minor pain and, other than applying too much which can burn the skin, does not have any known side effects. It apparently works by interfering with the transmission of pain signals to the brain. It doesn't treat the cause but seeks to mask the symptom--the pain.

Chiropractic: A treatment involving manipulation of the spine to relieve pressures of the vertebrae on nerves. Illness and pain can result if the nerves along the vertebrae are pinched or impeded because these nerves carry signals to and from the brain. However, all chiropractors are not the same. You should carefully select a chiropractor. Many chiropractors use techniques that do not involve "cracking the back" but accomplish the alignment of the spine using non-forceful methods that are often much more effective in actually treating the pain from pinched nerves and provide longer lasting benefits.

Exercise: It is logical that weak muscles can lead to problems with vertebrae alignment and the operation of the vital organs of the body. Light exercise, like walking, swimming and bicycle riding contributes to the blood and oxygen flow to our muscles and has been shown to work as well as or better than anti-depressants. Having had back problems for most of my life, I know that the exercises developed by Peter Egoscue, a physical therapist, can provide permanent relief of pain. Egoscue’s DVD’s and books are available in bookstores and online.

Genetics: For years, it baffled scientists how four people who suffer the same injury can recover in four different ways. One person has a complete recovery. The second person has a 60% recovery and only moderate pain. The third person has a 40% recovery and more severe but not disabling pain and the fourth person is totally disabled and suffering severe and disabling pain. Scientists studying DNA have discovered some explanations. A severe injury causes a reorganization of the nervous system known as plasticity. The nerve cells make new contacts and this disrupts a cell's supply of nutrition. Scientists believe that genetic therapies directed at preventing or correcting this reorganization of the nervous system will lead to non-surgical ways to alleviate chronic pain conditions.

Herbs: There are a variety of herbs that have been found to relieve pain. Corydalis is an herb native to the Chinese province of Zhejiang and is used in Chinese medicine for pain relief. Prescribed for many of our patients by a pain treatment doctor located in Palm Harbor, Florida, Relxgesic ES contains mostly corydalis and has been effective in helping alleviate the pain that may still be present as someone detoxes at Novus. There are numerous other herbs that have helped with pain. While the herbs can adversely react with other medications, depending on your metabolism and DNA, they normally do not present the same harmful side effects as pain killers.

Hydration: By hydration we mean the amount of water in the body. While the value of hydration to the proper operation of the body may not put it in a class by itself as an effective treatment protocol, as Bum Phillips, former coach of the Houston Oilers, said about star running back Earl Campbell, "If he isn't in a class by himself it don't take long to call the roll."

The percentage of the body that is water is between 65% and 70%. Our brains are 85% water and the neurotransmitters that communicate with the various receptors and control our bodies do so through water. All of our cells float in fluid and our organs are made up of cells. When there is sufficient water in the body, our organs work to their capacity and are able to repair many injuries, effectively fight disease and increase the production of endorphins-our body's natural pain relievers.

Our diets seldom result in us getting sufficient water. Instead of water, most people drink coffee, sodas or tea. For this reason, most people's bodies are operating like the eight cylinder car that is only firing on five cylinders-it can still get around but places enormous stress on the engine. At Novus, we believe that one of the reasons that people are able to detox more comfortably is that we make sure that they are hydrated and stay hydrated. Drinking water with electrolytes in sufficient quantity to keep the body hydrated is something all of us can do.

Physical Therapy and Rehabilitation: This is a process normally performed by a licensed physical therapist but also can include exercise and massage. Properly done, physical therapy can actually strengthen damaged parts of the body and permanently reduce pain.

Placebos: Placebos are inactive substances, such as sugar pills. There is evidence from scientifically performed clinical studies that suggests that placebos reduce the intensity of many pain conditions such as migraine headache, back pain, post-surgical pain, rheumatoid arthritis, angina, and depression. This is known as the placebo effect--the observable or measurable change that can occur after administration of a placebo. Many believe that placebos work because the patients believe or expect them to work. Others say placebos relieve pain because we stimulate the brain's own analgesics (pain relievers) and stimulate the body to begin healing itself.

Transcutaneous Electrical Stimulation (TENS): A TENS machine sends tiny electrical pulses through the skin to nerve fibers that cause changes in muscles. TENS can produce temporary pain relief but there is evidence that in some people the pain relief is more permanent.

CONCLUSION

While none of the above treatments is going to work for everyone, the thing that we know is that doing nothing about the cause of the pain is a sure way for it to get worse. We also know that taking pills to mask the pain will inevitably lead to not only a worsening of the cause of the pain but also will condemn the person to a life of drug dependency and/or addiction. At Novus Medical Detox Center, we will withdraw you from painkillers and work to help you find alternative methods of handling the pain and the cause of the pain.

NOTE: This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine, health care diagnosis or treatment, or (iii) the creation of a physician patient or clinical relationship. If you have or suspect that you have a medical problem or that this information may be useful to you or others, please consult with your health care provider before applying any information from our articles to your personal situation or to the personal situation of others.